U.S. global AIDS blueprint must address those at greatest risk, groups say

Echoing Secretary Hillary Clinton’s call for a United States plan to fight the global AIDS epidemic, representatives of 12 organizations and institutions have sent a letter to U.S. Global AIDS Coordinator Ambassador Eric Goosby, detailing the ways the plan should address the needs Clinton said must be addressed in the plan: those of people who inject drugs, who sell sex, who are transgender and men who have sex with men.

The document, which was signed by representatives of Johns Hopkins University, amfAR: the Foundation for AIDS Research, the Open Society Foundations, ACT V: The End of AIDS, and others, including the Infectious Diseases Society of America’s Center for Global Health Policy, which staffs this blog, can be found here.

Citing research and statistics published over the last several years, including in articles in the journal Health Affair‘s pre-2012 International AIDS Conference edition examining the President’s Emergency Plan For AIDS Relief, the document explicates five ways an effective plan would need to address previously neglected challenges — in reaching those at greatest risk, in scaling up programs in proportion to needs, in research, in program evaluation, and in protecting human rights.

Among the findings cited in the letter:

Less than one percent of PEPFAR dollars in 55 countries went to prevention efforts for men who have sex with men

Currently less than one percent of PEPFAR money goes to efforts aimed at people who inject drugs

67 percent of countries have reported laws and policies that block access to HIV services

The letter notes that while the Office of the Global AIDS Coordinator has issued responsive guidelines for programs working with people using injecting drugs and men who have sex with men, it also needs to clarify guidelines on programs providing prevention and treatment for sex workers, to address confusion fostered by the government’s “prostitution pledge” requirement. The requirement demands that organizations receiving U.S. funds “explicitly” oppose prostitution, prohibits speech or action that would appear inconsistent with that stance, and has led to constrained efforts, the letter says.

The letter acknowledges that legislatively enacted funding restrictions – against syringe exchange, as well as the anti-prostitution pledge – compromise effort, but it suggests that the blueprint could either look to a time when the restrictions are repealed or call for such a repeal so that funds can be used more effectively.

This week Science Speaks will begin a series of posts in which prominent researchers, clinicians and advocates discuss their views on what an effective blueprint for the global AIDS response should include.